Moms who need to express their milk exclusively or in addition to breastfeeding are often concerned about their milk production. Combining breast massage and hand expression with pumping can help moms remove more milk. Draining the breasts more fully enhances milk production, both now and in the future.

What is Hands-on Pumping?

Hands-on pumping is a milk expression technique that was developed by Dr. Jane Morton and studied at Lucile Packard Children’s Hospital and Stanford University School of Medicine. Instead of relying on the vacuum of the pump alone, moms use their hands to assist in milk removal while pumping. Breast massage and hand expression combined with pumping has been shown to maximize milk removal and subsequently, maximize milk production.

Why Hands-on?

85 percent of moms with babies between the ages of 1.5 and 4.5 months of age have used a breast pump (Labiner-Wolfe 2008)

The perception of not making enough milk is one of the top three reasons moms give for weaning (Li 2008)

When a baby breastfeeds effectively, he uses a combination of vacuum and the action of the jaw and tongue to remove milk (Geddes 2007)

The vacuum of a pump alone is less effective at removing milk that is thick and sticky like colostrum or fat-rich breastmilk (Steakly 2012)

Hands-on pumping increases the amount of fat-rich and calorie-dense milk moms are able to express (Morton 2012)

Hands-on Pumping How-To

Massage your breasts to help stimulate the milk ejection reflex. Use your fingers held flat against your breast and gently massage in a circular motion from the point where the breast meets the chest in a downward direction towards the nipple.

Double pump. Assure your breastshields fit well. Find a level of suction that is comfortable and effective for you. Consider using a “hands free” pumping bra, bustier, or sports bra with holes cut for the breastshields so that you can pump without having to hold them in place. This frees your hands so you can massage and compress your breasts while pumping.

When the sprays of milk slow to dribbles, stop pumping and repeat massage. Feel for areas of firmness. With gentle pressure, massage behind any area that still feels firm in a downwards direction towards the nipple.

Use your hands to compress and massage while single pumping.Image copyright Beth Walldorf–All rights reserved

Single pump or hand express to complete your pumping session. Alternate breasts (right to left to right). Give each breast a short rest before expressing it again. Feel for areas of firmness and gently massage them out. Pay close attention to the outside of the breasts, as this will be the areas least likely to be well drained from pumping alone. Let the sprays of milk be your guide as to where your breast needs compression and massage. Experiment and develop your own technique. With practice, you will find what works best for you!

Consider warming your breastshields before pumping. One study found that using warm breastshields along with maximum comfortable vacuum decreased the time needed to remove 80 percent of the milk volume.

If you have difficulty initiating letdown, Reverse Pressure Softening can help by stimulating the nerves that lie under the areola. These nerves control the release of the hormone oxytocin, which is responsible for milk release. Most moms can initiate letdown with RPS in 1-2 minutes. It is especially helpful when engorgement makes latching or pumping difficult.

Choose a breastpump that is right for your pumping needs. Talk to an IBCLC to get personalized assistance finding a pump that works for you.

Beth is an experienced and talented artist who works in a variety of mediums, most notably oils and acrylics. She holds a BA from Jacksonville State University and currently teaches art at Decatur High School. She and her husband live in Decatur, AL with their two girls who were both breastfed. Thank you, Beth, for sharing your time and talents for this project!

I decided when I found out I was pregnant, to do all that I could for my child from the start. I changed my household and beauty products. I began to strictly buy the best food available. Thankfully, it is not hard to achieve this on the SF peninsula. I contacted a doula in my area who also became my Yogi & guide to meditation, which I have always struggled with. Early on I decided that my birth would be natural and my children would be breastfed.

Being born in late 70′s to a Mexican immigrant I was not breastfed. It just, “wasn’t done”, was my mothers only explanation. Her mother did not breastfed her children either. Back then they had wet nurses that did the breast feeding. I can not imagine missing out on the connection breastfeeding gave me with my children. But that was part of the culture at the time and I am not willing to judge their choices. Especially since my family was understanding & very supportive of mine.

My sons birth was wonderful and peaceful. Lasting only 3 hours from start to finish. With my Abuela, my Mothers, and husband present. They prayed they even sang, it was wonderful. My doula was an amazing advocate for my choices in the labor & delivery room and after. My son latched on without a problem in the hospital and we were sent home on schedule.

Our first night home was another story completely. It was near 100 degrees and I became so engorged that he could not latch. We cried together most of the night. I called the lactation nurse in a panic she gave me some advice that I did not execute well. After another desperate call full of tears we made an appointment for a at home visit the next day. She came over bright and early and changed our lives. Diego was able to latch and ate with gusto. I decided to join her lactation support group at the local hospital which met once a week. It was pretty much a huge meeting room with chairs lined along the walls women of all ages and races with our brand new to 2 year old babies. That group was my lifesaver throughout the first six months of my son’s life. Whatever questions or thoughts we had we voiced them there. It was a safe space to talk amongst supportive women going through the same things. I learned so very much from them all, and made some forever friends.

At that point my son was a happy very chubby baby that no one could believe I only breastfed. People often commented on the fact that they, “knew”, breastfed babies were skinny, less healthy looking, and never slept through the night. We changed their minds about that quickly. I had decided that I would breastfeed my children for a year. It seemed like a substantial enough amount of time but I was not opposed to breastfeeding for longer if they needed.

When my son was 7 months old I found out I was pregnant with my daughter. Being that my son was such a healthy eater, breastfeeding began to drain me. I was exhausted, I began to try to pump to freeze a reserve for him in case I could not longer continue. Since I am in this country alone without my family I had never been separated from my son at all. I had never had to pump or give him a bottle. This was challenging, he detested the bottle. I bought every brand available no matter the price with no success. I began to donate my stored milk to mothers with low supply or mothers who had adopted infants so that it would not go to waste. Finally we found a nipple he would take. I began to give him one bottle a day just to get him used to the idea. He turned a year old and I began to wean him off my breast, more bottle than mama; I also continued to pump. By the time he was a year and 3 months he was only being bottle fed and had 3 months of stored supply. I was too tired to continue.

When my daughter was born I obviously began the whole process again. He showed some interest, so I fed him from time to time. But he lost interest within a couple months. The world was his oyster now that he was mobile. With my daughter I introduced the bottle a little earlier. I stayed most of that year in Mexico with my family and had help with my daughter so that I could take my son out for some bonding time just he and I. I did not want him to feel jealousy of his baby sister. She was another happy chubby breastfed baby that slept and ate very well. I began to wean her at a year and a month old. And by a year and 4 months she was drinking the 3 months of stores milk I had for her. Breastfeeding was a wonderful experience for me and my children. It took some of my family members some getting used to me feeding in public. But I made sure to do my best to be open to their questions or comments.

I wore my children for the first year of their lives which is “not done” in Mexico any longer either. The classes are less defined today but still exist and the lower classes are the only people you will see feed their children in public or wear their children. Our friends and neighbors became used to seeing me wearing my babies and stopped staring. I am happy to see a change in this generation of a larger middle class. Hopefully soon there will be more education and support for breastfeeding there as well. I have spoken to all my nieces of my experience and a few have even followed my lead. Becoming a mother has made my life so much more meaningful. And I am blessed to have been able to give my children the best start in life possible. I wish that for us all.

We apologize for our lack of posts these last few months. Our writing team is busy, busy, busy with family, school, and work. There never seem to be enough hours in the day to do all we would like and writing has unfortunately hit the bottom of the collective “to do” pile. Expect more posts from us near the holiday season (aka winter break). We have many exciting posts in the works, including some just for moms who need to express their milk. There will be guest posts, too!

In the meanwhile, please tell us what topics YOU would like to read about. We welcome your ideas (and perhaps even your guest post). Don’t forget to check us out on Twitter and Facebook. Use the quick navigation buttons on the right hand side of the page to take you there.

Thank you for your continued support of Native Mothering. We couldn’t do it without you!

You are welcoming a new baby to the family. Congratulations! Breastfeeding is one of the healthiest, most rewarding things a mom can do for her baby. It is only natural that you want to support the new mother in breastfeeding and to make it as easy as possible for her to succeed. Here are a few tips that you may find helpful along the way.

1. Learn more about breastfeeding before the baby arrives. Reading books and articles from respected, evidence-based resources can help you gain a better understanding of how breastfeeding works and what to expect. Talking to other mothers about their breastfeeding experiences can also be a valuable way to learn.
2. Support her choice to breastfeed. Let her know you’ll do what you can to help her breastfeed as long as she desires. Don’t try to persuade her to offer bottles of breastmilk or formula when not medically indicated. Remember that there are many ways for family members to bond with the baby besides feeding.
3. Bring her water or her favorite beverage and a snack. Breastfeeding can make moms feel thirsty and hungry. New moms tend to care for their babies before themselves, and their own needs may go temporarily unmet without a little help. A refreshing drink of water in the middle of a marathon feeding can really make a new mom’s day!
4. Give her a break. After she breastfeeds her baby, offer to hold, rock, or carry the baby in a sling or front carrier while she rests (or showers, or goes for a walk around the block, or…). Assure Mom you will let her know when baby shows early signs of hunger.
5. Help her with baby care. Offer to change the baby’s diaper or bathe the baby while she takes care of her own personal needs.
6. Help with the chores. Ask Mom what she needs you to do or ask her to leave a list on the refrigerator. Laundry, vacuuming, sweeping, cooking, dishes, and grocery shopping are chores that most often top the “to do” list.
7. If there are older children, read to them, play with them, or take them out for the afternoon. The one-on-one time will be special for them, and Mom will appreciate the time to bond with her new baby.
8. Entertain house guests and enable Mom to have a quiet space alone with the new baby. During the early weeks it is common for babies to spend a lot of time breastfeeding. Mom will still be healing after birth, and entertaining for long periods of time may be tiresome. She may even feel uncomfortable breastfeeding in front of certain people. Entertaining guests can help take the pressure off of Mom to be sociable and allow her time and space to rest and bond with her baby.
9. Help her deal with criticism about breastfeeding. Remind her of all things she is doing right. Provide her with unbiased, evidence-based information that will help her overcome the criticism (for example, if she is being criticized for not supplementing remind her of how to tell her baby is getting enough milk). If necessary, step in and speak for Mom in a good way.
10. Tell her you’re proud of her for breastfeeding. Your encouragement and support could be the difference between her continuing with breastfeeding as long as she plans to or stopping before she is ready. You are an important part of her success!

New mothers need to be out and about with their babies and often have lots of questions about breastfeeding away from home. Here are some easy tips to help you breastfeed fearlessly anywhere.

image used with permission–do not copy

1. Attend a breastfeeding support group or meet-up and see how other moms are breastfeeding confidently in public. Confidence is contagious!

2. Practice makes perfect! Practice your breastfeeding technique at home in front of a mirror or with a trusted friend or family member who can tell you what they see from angles that you can’t see. Maintaining the level of modesty that you desire gets easier with trial and experience.

3. Wear a bra that allows easy access with one hand. Being able to hold your baby and access your breast with one hand makes latching on a virtually seamless move.

4. Is latching on the most awkward part for you? Try leaving the room or turning your back while your baby latches on. When baby is nursing comfortably, return to what you were doing as if nothing happened. Smooth.

5. In a restaurant, sit with your back to the crowd. No one is likely to notice your quietly breastfeeding baby from behind. A roomy booth provides the most comfort and privacy.

6. A baby cradled close in mom’s arms looks like a sleeping baby. Most bystanders won’t even notice you’re breastfeeding. See someone looking your direction? Make eye contact and smile!

7. Pull your shirt up from the bottom rather than pulling your breast out over the top of your shirt. Wearing a shirt that it is a little loose will give you the most coverage all around.

8. Looking for more coverage? Wear clothes or undergarments (such as nursing camisoles) that are designed for breastfeeding moms. They offer strategically-placed access holes that allow you to breastfeed while remaining comfortably covered whether you want complete modesty or just to cover your post-pregnancy tummy. For an inexpensive alternative, cut slits into a regular tank top or camisole and wear it under any shirt you already own.

9. Breastfeed while carrying your baby in a sling, wrap, or other soft carrier. The fabric of the carrier will help keep you covered. Bonus: You can walk, do chores, or a million and one other things while you are wearing your baby.

10. Still feeling shy about breastfeeding in public? A nursing cover or blanket thrown across your shoulder and your baby offers full coverage and can provide for complete modesty.

Remember: Anything that helps you feel comfortable and confident while breastfeeding in public is right for you. There are no rules! Do what works best for you and your baby and makes breastfeeding an enjoyable part of your everyday life.

Many mothers wonder how their diets may affect the quantity and quality of their breastmilk. With so much emphasis in both the popular media and the medical literature on the effects of processed foods, sugar, and artificial ingredients on health, women who have difficulty eating a more natural diet may worry that breastfeeding might not always be the safest or most nutritious choice. Maybe you have heard that you should change your diet while you are breastfeeding, or perhaps you have been told that it’s fine to eat “whatever you want.” Here are some answers to these questions. Please contact us via the website or Facebook page if your question does not appear here.

I have heard that the way we eat today puts us at higher risk for illnesses like diabetes and heart disease. What about my baby’s health? Is my milk still best for him?

Yes! Even if your diet contains more processed and convenience foods than is best for your health, your milk will still be the best available food for your baby.

It is clear from the research that breastfeeding is the single best way for a mother to safeguard her infant’s health: babies not breastfed have higher risk of diabetes, diarrhea, ear infections, rashes, allergies, childhood cancer, respiratory illnesses, asthma, and SIDS, (Bartick & Reinhold, 2010; Stuebe, 2009), and the protection offered by breastfeeding does not depend on the mother’s diet.

Formula, whether milk-based or soy-based, factory-produced or homemade, can never provide your baby with all the specific nutrients and immune factors essential for his health. Your milk changes composition in order to best meet your baby’s needs as he grows. Also, breastmilk contains immune factors to protect him against illness–no formula offers immune protection. While most infants can survive and grow on formula, some ingredients are associated with health problems. The proteins in formula are different from the proteins in your milk and are associated with increased risk for certain diseases like juvenile diabetes (Virtanen et al., 1994; Kolb & Wassmuth, 2000) and colitis (Host, 1994; Savilahti et al., 2010). The iron in formula is less available and harder to absorb than the iron in your milk, and it may cause undesirable changes in your baby’s gut bacteria (Balmer & Wharton, 1989; Mevissen-Verhage et al., 1985). When considering how to feed your baby, remember that milk from your breast is always fresh. Formulas, whether homemade or store-bought, carry the additional risk of contamination with disease-causing bacteria from processing facilities (Power et al., 2013) or farm animals.

Research has found little significant variation between the milks of mothers with different diets. For example the amounts and types of fats may vary (Cruz-Hernandez et al., 2013; Innis & Kuhnlein, 1988), but no diet has been found to result in breastmilk that is inferior to formula or inadequate to meet an infant’s needs. Humans are “omnivores” and have the ability to both stay healthy and produce high-quality breastmilk on diets that vary widely in both composition and quantity of foods. When your body makes milk, it produces the nutrients, non-nutritive elements, and immune factors your baby needs in the proper quantities (Hassiotou et al., 2013).

Even if a formula were just as nutritious as breastmilk, breastfeeding is about so much more than the milk. It is a special relationship that is uniquely yours–something only you can do for your baby. Breastfeeding keeps your baby safe and warm, promotes normal sleep patterns, allows normal brain development, and develops his immune system (including his thymus gland). The breastfeeding relationship cannot be bottled, and breastfeeding is best for your health, too.

My diet is limited to my budget, and I don’t always have access to fresh fruits and vegetables–is my milk still nutritious?

Absolutely! Your milk is always the most nutritious food for your baby, even if your diet is not as varied and nutritious as recommended by health experts. Information about nutrition during pregnancy and breastfeeding may not take into account the limitations that many mothers face: lack of food, limited access to fresh foods, and limited or no access to common food-preparation needs such as running water, stove, refrigerator, or microwave. That said, eating as wisely as possible is best for your health and that of your children. Cutting back on fast and convenience foods and increasing your intake of fruits and vegetables and other whole foods will be better for your health, especially for reducing the risk of diabetes and heart disease. If you are in a situation that limits the food you have available, here are some ideas:

Buy fresh fruits and vegetables from a local fruit stand, farmers’ market, or Community Supported Agriculture (CSA) organization. They are usually cheaper than your local grocery store (especially if you live where convenience stores are your main shopping centers or where fruits and vegetables are usually trucked or flown in). Many accept SNAP benefits or WIC cash value checks. You may even be able to barter for fresh food this way simply by asking.

Keep dry ingredients like beans, rice, and pasta on hand: they make inexpensive bases for healthy meals.

Pre-packaged “health foods” like granola bars and cereals are costly and often have unnecessary added sugar. Making your own snacks from bulk ingredients like nuts, oatmeal, cornmeal, and whole-grain flour costs less than buying commercial snacks and are healthier because you control the ingredients.

Build your weekly or daily menu around what is on sale at your local grocery store. Shop for markdowns in the meat, produce, dairy, and bakery sections. These sales may save you 30-50% of the cost.

If you do most of your shopping at convenience stores, choose more healthful options like mixed nuts instead of potato chips.

If you use a food bank, don’t be afraid to ask specifically for healthy foods.

Remember that WIC and SNAP both allow produce purchases and make special allowances for families who have limited resources for cooking and food storage (for example, SNAP would allow you to purchase hot foods from a grocery store). Both agencies provide nutritional counseling, as well as food-preparation classes.

Your tribal or community wellness agency may provide nutritional counseling and special assistance in buying wholesome foods.

Your body will use your stores of vitamins and minerals to ensure that your milk has exactly what your baby needs. Finishing the prescribed prenatal vitamin is usually enough to meet your own health requirements (Nutrition During Lactation, 1991). However, if your diet is high in processed foods, you eat fewer than 2700 calories per day, you avoid or limit certain food groups, or you have any health conditions that may limit how well your body absorbs nutrients or vitamins, nutrition counseling is recommended. Increasing your intake of certain foods and food groups is likely to provide a greater benefit than a supplement (Lawrence & Lawrence, 2011).

Even though you are able to produce high-quality breastmilk on a diet deficient in some nutrients, when you take in more vitamins and minerals through supplements and dietary changes, some of them also increase in your milk. If you take in more of vitamins A, D, B1, B2, B3, B6, or B12, your milk will have more of these vitamins as well. Fatty acid and iodine supplements may also influence quantities in your milk. (Valentine & Wagner, 2012).

If you are concerned that you or your baby may not be getting enough of all the vitamins you need, talk to your health-care provider. She may recommend simple testing or vitamin supplements. Breastfeeding is still best in these situations.

Do I have to eat certain foods or take supplements in order to produce enough milk?

No. However, in some cultures it is customary to eat certain foods after the baby is born in order to promote milk production. Interestingly, many of these customary “mother foods” are packed with B vitamins, iron, calcium, protein, antioxidants, and anti-inflammatory properties, which may help support lactation nutritionally. If your traditions recommend eating (or avoiding) certain foods after birth, you should feel encouraged to do so.

Sometimes mothers are told they need to take a certain herb, drink a commercial herbal tea, drink cow’s milk, eat oatmeal or oatmeal-based “lactation cookies”, or even drink one dark beer each night in order to produce enough milk. While most of the recommendations aren’t harmful, and some may even be beneficial from a nutritional standpoint, they aren’t likely to make or break your breastfeeding relationship. Milk production is controlled inside the breast, by the frequency and thoroughness of milk-removal. The best way to encourage your body to make all the milk your baby needs is to feed on demand.

Please keep in mind that alcohol consumption should be limited while you are breastfeeding. Always talk to your health-care provider or traditional healer before taking any herbs or over the counter medications. If you are concerned about your milk production, talk to an IBCLC or other breastfeeding support specialist.

Can I diet while breastfeeding?

Reducing the number of calories you eat daily and avoiding desserts, sodas, chips, and other foods with “empty calories” will not cause your milk to lose nutritional value. Many mothers find that breastfeeding alone helps them lose the extra weight they gained during pregnancy. It is possible to lose additional weight through restricting calories while you are breastfeeding, but the current recommendation is that the diet not include fewer than 1800 calories per day (Lauwers & Swisher, 2011).

Are there foods I should avoid while breastfeeding?

The short answer is that there are no foods all mothers should avoid. Diets vary around the world, and so do the traditions of foods to eat or avoid while breastfeeding. Many experts recommend avoiding fish that are known to have high levels of mercury (tuna, swordfish, and others), foods like margarine that are high in trans fats, and foods that are common allergens like peanuts. However, the research on these topics is incomplete. Discuss any dietary restrictions you would like to make with your health care provider or IBCLC. It should be noted that milk-based formulas, including homemade formulas, contain trans fats (Mozaffarian et al., 2006; Satchithadandam et al., 2002; Ratnayake et al., 1997), and most formulas contain common allergens such as animal milk or soy proteins.

I have heard that certain diets will make my milk much healthier for my baby. Should I still breastfeed if I don’t eat a traditional or natural-food diet?

Definitely. While a diet rich in fresh fruits and vegetables and low in processed foods is an ideal choice for your and your family’s health, breastfeeding always provides the best possible nutrition for your baby, even if your diet is not as wholesome as it should be. A mother eating a typical American diet and a mother eating a whole-food diet may have some different types of fat and slight differences in the levels of some vitamins in breast milk, but this variation is not as great as the nutritional difference between broccoli and candy. Your milk is still best, even if your diet is not.

I have heard that what I eat and drink goes into my milk–so if I eat french fries or drink soda, my baby gets the same fat and sugar through my milk?

The old adage “you are what you eat” sounds catchy, but it is not helpful to breastfeeding mothers wondering if their milk is nutritious enough for their babies. Most of the nutrients found in your milk do not pass directly from your food to your blood to your milk–the process your body uses to produce breastmilk is much more complex. Many substances in the foods you eat are never found in your milk, while others can pass through. However, no matter how much junk food you eat, there is no evidence to support the idea that your milk is not the best available food for your baby.

If my milk is still the best choice for my baby, why should I bother to try to make healthier food choices for myself?

Your health is important, too! Breastfeeding helps protect you from diseases like breast cancer (Bartick & Reinhold, 2010; Stuebe, 2009), but your diet is also crucial in maintaining your health. Also, your baby will not be breastfeeding forever–he will soon learn to eat table foods, and he will want the same foods he sees on your plate. Now is the perfect time to begin making those changes in your diet which will help your baby learn to eat healthily, and the foods you eat will flavor your milk so he will grow accustomed to their tastes. Some first table foods for your baby are also great for you: sweet potatoes, avocados, bananas, beans, lean meats, and oatmeal are simple to prepare, easily mashed with a fork, and very nutritious. Fresh ingredients cost less than prepared baby foods and cereals, and they are free of added sugar and other unnecessary ingredients.

All children benefit when their parents are healthy, and good health will allow you to have the energy and positive mood you need to meet the intense demands of motherhood.

Is it true that you shouldn’t eat “gassy” foods like broccoli, onions, and beans while breastfeeding?

Don’t worry! These vegetables are great choices for breastfeeding mothers. Even if they give you gas, the substances in them that can cause gas do not get into your milk.

I am diabetic. If my blood sugar is high, will my milk have too much sugar?

No–your body produces the main sugar in your milk, lactose, in the breast, and the amount of sugars in your milk remain fairly constant no matter how high the level of glucose in your blood may be (Dewey et al., 1991). Many mothers find that breastfeeding keeps their blood sugar lower than it was before they were breastfeeding, but if your blood sugar does get too high, do not worry about your milk–glucose only makes up a tiny percentage of all the sugars in breastmilk (Butte et al., 1987). However, if you have uncontrolled diabetes, you should seek treatment from your health-care provider as soon as possible for the sake of your own health.

You may be happy to know that breastfeeding reduces the risk of your child’s developing both obesity and diabetes.

I keep hearing conflicting advice about breastfeeding, and I am so confused! Where can I find the most accurate information?

Breastfeeding is a hot topic in the media right now, and many people are eager to voice their opinions. Many mothers are unsure where to turn for answers. Fortunately, there are trained professionals who have access to high-quality research and can help. Find them here:

Because breastfeeding can have a positive lifelong effect on your baby’s health and development as well as your own health, its importance is widely recognized in the health-care field. However, many mothers find themselves unsure where to turn for help or information when problems related to breastfeeding arise. New mothers may be especially overwhelmed by the volume of information that is shared with them or confused by conflicting advice given by different caregivers. This article presents a guide to the different types of breastfeeding support specialists you may seek out or encounter as you begin your breastfeeding journey.

Your family, friends, and community may influence your decision to breastfeed and will be an important source of support after your baby arrives. Sometimes you simply need a little encouragement, a nutritious meal (that you didn’t have to prepare), or the company of a friend to keep you going through breastfeeding challenges. Your partner, mother, grandmother, auntie, friend, or even a stranger on the internet can help you find information you need or offer “been there, done that” advice. If you need more specialized information, help, or connection to the social support of a breastfeeding group in your community, trained breastfeeding specialists are available to fill the need.

There are many different training programs available to the aspiring breastfeeding support specialist or volunteer. The resulting “alphabet soup” of initials can be downright confusing, even for people who work with breastfeeding moms! Understanding what the initials stand for, as well as what training, education, and experience is required to earn them, may help you choose whom to call if you need breastfeeding help and support.

Professional Fellowship and Certification

Professional fellowship and certification requires post high school education, including health education that provides an understanding of whole body systems and how they affect lactation. Professionals perform clinical evaluations of breastfeeding and create and oversee a plan of care, which may involve more than one type of health-care provider. One factor that sets professionals apart is the requirement to follow an ethical code of conduct overseen by the organization that provides the fellowship or certification.

Breastfeeding Medicine Specialist (Fellow of the Academy of Breastfeeding Medicine–FABM)

Breastfeeding Medicine Specialists are Medical Doctors (MD or DO) who have completed additional training in breastfeeding and human lactation and specialize in this field. They are able to treat complicated breastfeeding issues that require evaluation by a physician such as failure to thrive (a baby not gaining weight, not growing as expected), tongue tie, breast abscess, low milk production that is not resolved by more frequent nursing/expressing, and breast or nipple infections. They are also able to assist with common and ordinary breastfeeding problems as well as concerns that relate to the normal course of breastfeeding.

Breastfeeding Medicine Specialists often work in either private or group physician practices. They may work entirely in the field of breastfeeding medicine or use their breastfeeding expertise while working in another medical speciality such as obstetrics, pediatrics, or family medicine. Most often, mothers are referred to FABMs by an IBCLC or another physician who recognized an issue that required their expertise. As with most physicians, however, mothers may self-refer.

Education and experience:

An applicant must have completed the required education and training to become a physician, additional education in lactation science and management, as well as the required clinical experience hours working directly with breastfeeding mother-baby pairs.

Breastfeeding Medicine Specialists are recognized by the Academy of Breastfeeding Medicine to have “demonstrated evidence of advanced knowledge and skills in the fields of breastfeeding and human lactation. FABM denotes that the physician has ongoing specialized professional activities related to clinical expertise, research or teaching experience, and/or significant advocacy efforts in the field of breastfeeding medicine.” See the full reference here. Breastfeeding Medicine Specialists must apply to maintain their fellowship every 10 years.

Breastfeeding Medicine Specialists can:

make a medical diagnosis

prescribe medication

order and perform medical testing

perform medical procedures

Find a Breastfeeding Medicine Specialist:

Currently, a publicly accessible database is not available. You may call the Academy of Breastfeeding Medicine and ask how to contact the closest Breastfeeding Medicine Specialist to you.

IBCLCs are allied health professionals who have completed extensive, comprehensive education in breastfeeding and human lactation, education in health sciences and related subjects, and the required hours of supervised clinical experience. By passing the IBLCE exam, they have demonstrated they are qualified to work with breastfeeding mother and baby pairs as clinicians. IBCLCs can help mothers overcome common breastfeeding difficulties such as sore nipples, mastitis, and milk production concerns. They can also provide assistance with more complex issues, such as breastfeeding with illness or disability, low weight gain, and tongue tie. IBCLCs also help with concerns related to the normal course of breastfeeding (sleep, returning to work or school, etc.).

IBCLCs may work in private practice, group practices, hospitals, birth centers, health clinics, parenting centers, WIC clinics, physician practices, midwives practices, chiropractic practices, or multi-faceted practices such as perinatal clinics. They are part of the maternal-child health team and coordinate care with physicians and other health-care professionals. Additionally, IBCLCs may work in research, advocacy (including policy-making), non-profit management, or as volunteers. IBCLC is a stand alone credential, though many practicing IBCLCs are also licensed professionals such as physicians, registered nurses, or registered dietitians.

Education and experience*:

At least 90 hours of education specific to breastfeeding and human lactation

At least 1000 hours of supervised clinical experience working with mother and baby pairs, or 300-500 hours of directly supervised clinical experience with a mentor

A degree in one of the health sciences OR completion of the following courses:

The eligibility requirements above were implemented in 2012. Please note that these requirements have changed several times since the exam was first administered in 1985. See this presentation from IBLCE for full details. Depending on which year an IBCLC took the exam, and which pathway was taken, the candidate was required to acquire between 1000-8000 supervised clinical experience hours or 300-500 clinical experience hours that were directly supervised by an IBCLC mentor before applying for the exam. It is also of note that many candidates have more lactation-specific education hours than required at the time of application not only because they attend conferences and webinars earning Continuing Education Recognition Points (CERPs) while working towards eligibility, but also because it takes many hours to cover all the topics in the exam blueprint. For example, one of the most popular comprehensive education programs available to IBCLC hopefuls is the 120-hour Health e-Learning BreastEd course.

The IBLCE exam contains 175 multiple choice questions of which 100 include clinical photos. The exam covers all aspects of breastfeeding and human lactation as well as related topics such as child development, pharmacology, nutrition, anatomy and physiology, and ethics. All IBCLCs must recertify every five years by CERPs (a total of 75 hours) and at least every 10 years by exam.

assist the mother to find comfortable and effective positions for breastfeeding

assess the mother’s milk production and provide education and assistance regarding adjusting milk volume if necessary

use the appropriate World Health Organization growth chart to assess the breastfeeding child’s weight and growth patterns

evaluate and demonstrate the use of breastfeeding techniques and devices and provide evidence-based information to mothers about their use

write a comprehensive evaluation of a mother’s lactation history and breastfeeding assessment and work with the mother to develop and implement an appropriate and achievable breastfeeding plan

assess and provide strategies for initiation and continuation of breastfeeding in challenging circumstances such as a medical condition in mother or baby, compromised lactation, or emergency situation

provide information and strategies for overcoming breastfeeding challenges such as painful nipples, mastitis, and engorgement

empower mothers and families with information, support, and appropriate referrals to help them cope with peripartum mood disorders

educate mothers and families about normal baby behavior including signs of hunger and expected feeding and sleep patterns

provide current, unbiased, evidence-based information to assist the mother in decision making

obtain the mother’s consent to gather and disclose information and written assessments to pertinent health care providers

Find an IBCLC:

ILCA: Find a Lactation Consultant Directory-IBCLCs who are also members of the International Lactation Consultant Association may choose to have their contact information listed on this page. Due to that limitation, it may not be a comprehensive listing of all IBCLCs in your area.

Department of Public Health or WIC breastfeeding resource directory-Search your state Health Department or WIC website for this valuable listing of breastfeeding support resources in your community. It is usually updated annually.

Search-Most IBCLCs in private or group practice have a website and/or a Facebook page that is searchable using a web search engine such as Google or Bing. Searching for IBCLCs in a specific city or geographic region may help you narrow down the results. (For example “IBCLC New York, NY” or “IBCLC Bay Area CA.”)

Word of mouth and referrals-If you need the services of an IBCLC, you can ask your physician, nurse, or nutritionist for a referral. Your insurance company may have a referral list of IBCLCs that are covered under your plan. You may also find recommendations from from other women through parenting groups, breastfeeding support groups or meet-ups, and online groups.

Mother-to-Mother Support

Experienced mothers are trained in basic breastfeeding management, modeling optimal breastfeeding practices, and sharing (or facilitating the sharing of) information and experiences with pregnant and breastfeeding women individually and in group settings. Mother-to-mother support gives mothers the opportunity to talk with other women about their concerns in a way that might not otherwise be possible in today’s world. Women are empowered to explore options that are the foundation of a personally satisfying breastfeeding experience. Mothers often find it easier to share their concerns with other mothers; this mutual sharing of experiences and information builds trust and respect. Mother-to-mother support has the following benefits:

It is community-based and easy to access.

It provides an essential complement to existing health care and social services systems.

It enables and empowers mothers to make informed choices about breastfeeding and parenting.

It provides a social outlet for mothers (group meetings).

WIC Breastfeeding Peer Counselor (WIC BFPC or WIC PC)

Through the federal Women, Infants, and Children program, WIC Breastfeeding Peer Counselors provide mothers with breastfeeding information and support from pregnancy through weaning. During pregnancy, they visit with mothers by phone and in person to provide them with basic breastfeeding information, answer questions, and offer anticipatory guidance to help make breastfeeding easier. After a mother’s baby is born, her BFPC will continue to make regular contact with her, answer her questions, and offer practical suggestions to help her reach her breastfeeding goals. Depending on the policies of her state or tribal program, BFPCs may also facilitate support groups, teach breastfeeding classes, dispense breastpumps, certify participants for the WIC program, and make home or hospital visits.

Personal experience:

Breastfed for at least 6 months, WIC participant

Education and training:

20-hour on-site training that covers all aspects of the normal course of breastfeeding and human lactation as well as communication skills. Training activities include role play and demonstration of necessary skills including assisting moms with using common breastfeeding tools and equipment (such as breastpumps).

Volunteer Breastfeeding Counselors

The following volunteer organizations offer one-to-one breastfeeding counseling (which may include online or text communication and home visits), group meetings, and online resources. Counselors are educated and mentored within the organization before beginning to work with mothers. They may be supported by a network of professionals in the field of lactation that works as a sounding board for complicated situations.

La Leche League Leader (LLLL)

Personal experience:

Breastfed for at least 9 months at time of application; Please see additional requirements here.

Education and training:

Applicants must complete required reading, writing exercises, and role play which covers all aspects of the normal course of breastfeeding and human lactation, as well as communication skills. For full details, please see here.

Continuing Education:

Leaders are expected to keep up-to-date and are strongly encouraged to continue their education. Proof of completion is not required. To fill the need for continuing education, Chapters, Area Networks, and Regions regularly provide education opportunities such as seminars, conferences, lunch and learns, as well as informative publications such as Leaven and newsletters.

Certificate Programs

The following programs offer similar preparation to individuals who may provide mothers with information about the normal course of breastfeeding and basic breastfeeding support. After completion, they will be prepared to:

answer questions about common breastfeeding concerns such as prevention of sore nipples, preparing for return to work or school, and milk production issues

provide anticipatory guidance about common breastfeeding situations and problems

provide education to help mothers prepare to breastfeed or return to work or school

recognize when breastfeeding is going well and when more help is needed

recognize when a breastfeeding issue is beyond their scope of practice and refer to the appropriate professionals.Many certificate program graduates use their education in their occupations as nurses, nutritionists, midwives, labor doulas, postpartum doulas, baby boutique and pump rental station employees, or WIC Breastfeeding Peer Counselors. Some work as part of a group practice, usually with an IBCLC as the lead, while others start businesses to support women in their communities directly.

5 day on-site breastfeeding education (45 credit hours), role play, competency check (example: watch a short video and describe what action the CLC would take) and pass a 100 question exam with 75% or better immediately after program; Program information

Renewal: Every 3 years with 18 hours of breastfeeding education, plus required fee

Mentored online training, required reading and exercises, create portfolio of local breastfeeding resources, provide 30 hours of breastfeeding support, and complete final open book exam; Program information

The following certificate programs prepare candidates to provide breastfeeding education rather than support. Please see the program requirements and accompanying documents for more details, including the scope of practice of the certificated educators for each program.

For more information about, and a comparison of, the various breastfeeding support specialists in the USA please see The Landscape of Breastfeeding Support by the Massachusetts Breastfeeding Coalition.

Because of the immense importance of breastfeeding to both individuals and public health, it is imperative that our communities support and empower mothers both to initiate breastfeeding after birth and to continue breastfeeding as long as desired, ideally through the first year and beyond.

While it is helpful for mothers and community members to be aware of the diversity in breastfeeding specialists, these practitioners only represent one part of the larger picture of essential support for mothering. Breastfeeding specialists, community advocates, and health-care providers must work together with families in order to ensure that women have access to the accurate, evidence-based information and support they need to develop and meet their own breastfeeding goals.

Thank you to all the colleagues and friends who shared information to make this resource as comprehensive as possible. Special thanks to Adrienne Uphoff, IBCLC for her time and patience while editing and updating this article, as well as for the generous gift of her wordsmithing wizardry.

When weaning happens gradually, it is a process by which nursing frequency decreases slowly over time. The partnership between the mother and child during breastfeeding can be respected and honored if the weaning is done as compassionately as possible.

Mutual weaning happens when both the mother and the child are ready. Experts have described the natural age of weaning to be anywhere from about 2.5 years to around 7 years old, but weaning may happen before or after that age. Currently, the World Health Organization recommends that children be nursed for a minimum of two years.

How Weaning Happens

Breastfeeding should be able to continue unhindered as long as the relationship is working for both the mother and her child. Because there are two people in a breastfeeding relationship, the mother and the child’s feelings are equally important. Breastfeeding can be adapted to make it work for both of them if full weaning is not the best choice.

Parent-led: The mother may choose to drop feedings that are less important to the child’s emotional well-being and continue nursing at nap or bedtime. In some instances she may choose to night wean her toddler and continue to nurse during the day. It may be easiest to choose a daytime nursing-session as the first one to go, because it is can be easier to distract a child with other activities when it is daylight, and interesting things are happening.

Child-led: There are some toddlers who become so interested in the outside world that they are like little butterflies flitting from one thing to another. Sometimes, the result is that they begin to wean by nursing less frequently during the day and more during the night. Other children gradually stop nursing on their own over the course of weeks, months, or even years.
When a mother is ready to wean a child who can communicate well, she may try nursing only when the child asks. How long this process takes depends on the child’s readiness for weaning. As weaning occurs, the mother and child will start the next chapter of their relationship, built from the core emotional attachments forged through breastfeeding and attentive mothering.

If the Mother or Child is Not Yet Ready to Wean

Optimal nursing allows both the mother and child to be comforted and relaxed. When circumstances change, and mother or child is ready to reduce or stop breastfeeding, weaning may be done in respectful and gentle way. Partial weaning and other creative strategies may help make breastfeeding more manageable.
Sometimes small adjustments to breastfeeding behaviors, such as instructing the child to ask before lifting mama’s shirt so that she doesn’t feel exposed, can be taught to children beforehand in order to increase the comfort level of the mother. Mothers who can make these small changes are able to both preserve the breastfeeding relationship and meet their own needs.
Only a mother knows when the time is right for weaning: mothers have unique, intimate knowledge of their children, and they may have an intuitive sense of the process. If weaning feels too early or difficult, or the baby is under a year old, it may be best to delay weaning until a more appropriate time.

Emergency Weaning

When weaning in a rush, the mother and the baby may have not have had much time to prepare emotionally. It can be a highly-charged time filled with a sense of loss or even anger at the situation. For some mothers, there is acute medical necessity for weaning: treatment with chemotherapeutic drugs or other medications contraindicated during breastfeeding (dangerous to take while breastfeeding) and without possible safer substitutions or maternal addiction to harmful substances.
A mother in these situations must often choose a difficult weaning process that is entirely mother-led, and it may occur far earlier than her baby is ready.

For the Weaning Mother

Careful attention to how engorged (full of milk) she is getting will alleviate the discomfort she experiences. If needed, there may be medications that her healthcare provider can offer to speed up the process of “drying” her milk up.

Breast Engorgement

When a mother is breastfeeding normally, the milk is removed regularly, and breastmilk production may continue without discomfort. If a mother suddenly stops nursing, her breasts will fill with milk and cause engorgement. Engorgement is usually very uncomfortable: it can make the breasts feel hot or heavy, and it is frequently painful.
Having full breasts sends a message to the breast to stop producing milk. A mother who is weaning should consider wearing loose, comfortable clothing to minimize pressure on the breasts during this transition.
Some mothers have reported that expressing (removing) some of their milk so that they are not painfully engorged is helpful. Removing a little milk can help a mom avoid feeling really uncomfortable. With milk expression, the goal is to remove just a little for comfort and not to drain the breast. A mother who is removing milk in this manner in order to wean rapidly because of a dangerous medication or medical condition should avoid feeding this milk to her baby unless her health care provider has advised her to do so.

Quick Comfort Measures

Cold packs, frozen peas, frozen cabbage leaf compresses, and other cool compresses on the breasts may help with engorgement pain. A mother can check with her health care provider to see if taking an over the counter anti-inflammatory medication is an option.

Occasionally some mothers experience blocked ducts or mastitis when they have been engorged for a long time. Some signs and symptoms of mastitis requiring prompt treatment from a health care provider include: a fever over 100 degrees, body aches, very painful breasts, red streaks on the skin of the breasts, or hot, hard places in the breasts.

Offering Another Method to Feed the Baby

Fluids may be offered in cups or sippy cups, bottles, or spoons. The liquids a baby should consume vary depending on his age. Some mothers may be able to acquire donor human milk for young or premature babies. Other mothers of babies under a year old will be advised to use an iron-fortified formula. Mothers of toddlers or older children may offer water or other fluids approved by their health care providers.

Some quick tips for weaning

Redirect a toddler with a special toy or favorite snack.

Offer a sippy-cup of water or expressed milk.

Offer another form of comfort.

Avoid places you usually nurse.

Go to the park more often, take walks, or get outdoors when you can.

Wear clothes with buttons or layers. Avoid clothes that are easy for your toddler to lift Don’t be afraid to nurse if weaning isn’t working well that day–there is always tomorrow.

Try to be consistent.

Be gentle, patient, and loving.

If you feel engorged, express some of the milk for comfort, but don’t drain your breast all the way.

Try a warm/cool bath or shower or cool compresses for breast discomfort.

Be kind to yourself–weaning is emotional work for both the mom and the child.

Once you have weaned, don’t express milk to see if any is there: give your breasts some time off from any handling.

A Mother’s Feelings about Weaning

Some mothers feel relieved that weaning has been achieved and that they have experienced the amazing feat of breastfeeding. Being pregnant and breastfeeding are tremendous accomplishments: all mothers, whether they nurse for a few weeks or years, should be commended for their efforts.
The physical sensations of engorgement and the emotional effects of not being able to nurse may be very difficult for other mothers. These women may feel that the hardest part of weaning is not being able to respond in the normal fashion to her baby’s need to nurse, cuddle on her breast, or reconnect after separation. A mother may miss the private time that nursing offered the two of them and may have feelings of regret or miss the tiny baby that she once held in her arms. Throughout the gradual weaning process, the adult can understand why weaning is happening, but a young child will not have the same experience. The mother may see some behavioral changes in her child during and after weaning. Obtaining the caring support of family or friends is helpful during this challenging period of adjustment and will potentially ease some of the strain placed on the mother-child relationship.
It is normal to feel “touched-out,” sad, relieved, anxious, worried, or frustrated. Mixed emotions are common. Finding another mother to speak with may be helpful. Mothers who are unable to discuss weaning with family or friends or who need further support should consider seeking out community support programs that offer free counseling to mothers in crisis as soon as possible.

If a mother experiences signs of depression or if she says she feels like hurting herself or her child, she should find help immediate.y. She could call 1-800-273-TALK or Chathttp://www.suicidepreventionlifeline.org/ There is never any shame in reaching out for help when it is needed.